TY - JOUR

T1 - Exertional Cardiac and Pulmonary Vascular Hemodynamics in Patients With Heart Failure With Reduced Ejection Fraction

AU - Edward, Justin A

AU - Parker, Hugh

AU - Stöhr, Eric J

AU - McDonnell, Barry J

AU - O'Gean, Katie

AU - Schulte, Margaret

AU - Lawley, Justin S

AU - Cornwell, William K

N1 - Funding Information: WKC has received funding from an NIH/NHLBI Mentored Patient-Oriented Research Career Development Award (# 1K23HLI32048-01 ) as well as the NIH/NCATS (# UL1TR002535 ), the Clinical Translational Science Institute at the University of Colorado Anschutz Medical Campus and the Department of Medicine at the University of Colorado Anschutz Medical Campus.

PY - 2023/9

Y1 - 2023/9

N2 - BACKGROUND: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but quantitative data regarding exertional hemodynamics are lacking.OBJECTIVES: Characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.METHODS: Thirty-five HFrEF patients (59±12 years, 30 males) completed invasive cardiopulmonary exercise testing (CPET). Data were collected at rest, submaximal exercise and peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO 2) were identified. RESULTS: Left ventricular ejection fraction and cardiac index were 23±8% and 2.9±1.1 L/min/m 2, respectively. PeakVO 2 was 11.8±3.3 ml/kg/min and ventilatory efficiency slope was 53±13. Right atrial pressure increased from rest to peak exercise (4±5 v. 7±6mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27±13 v. 38±14mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined. CONCLUSIONS: HFrEF patients suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population.CLINICAL TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03078972 LAY SUMMARY: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF). In this analysis, resting and exertional hemodynamics are analyzed from a contemporary cohort of patients with HFrEF (59±12 years, left ventricular ejection fraction 23±8%) during invasive cardiopulmonary exercise testing with upright cycle ergometry. During submaximal and peak exercise, large increases in left- and right-sided filling pressures were demonstrated. Maximal oxygen uptake was severely reduced and ventilatory efficiency was severely elevated. Multiple pulmonary vascular and right-sided hemodynamic parameters were predictive of functional capacity.

AB - BACKGROUND: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but quantitative data regarding exertional hemodynamics are lacking.OBJECTIVES: Characterize exertional cardiopulmonary hemodynamics in patients with HFrEF.METHODS: Thirty-five HFrEF patients (59±12 years, 30 males) completed invasive cardiopulmonary exercise testing (CPET). Data were collected at rest, submaximal exercise and peak effort on upright cycle ergometry. Cardiovascular and pulmonary vascular hemodynamics were recorded. Fick cardiac output (Qc) was determined. Hemodynamic predictors of peak oxygen uptake (VO 2) were identified. RESULTS: Left ventricular ejection fraction and cardiac index were 23±8% and 2.9±1.1 L/min/m 2, respectively. PeakVO 2 was 11.8±3.3 ml/kg/min and ventilatory efficiency slope was 53±13. Right atrial pressure increased from rest to peak exercise (4±5 v. 7±6mmHg,). Mean pulmonary arterial pressure increased from rest to peak exercise (27±13 v. 38±14mmHg). Pulmonary artery pulsatility index increased from rest to peak exercise, while pulmonary arterial capacitance and pulmonary vascular resistance declined. CONCLUSIONS: HFrEF patients suffer from marked increases in filling pressures during exercise. These findings provide new insight into cardiopulmonary abnormalities contributing to impairments in exercise capacity in this population.CLINICAL TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03078972 LAY SUMMARY: Exertional dyspnea is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF). In this analysis, resting and exertional hemodynamics are analyzed from a contemporary cohort of patients with HFrEF (59±12 years, left ventricular ejection fraction 23±8%) during invasive cardiopulmonary exercise testing with upright cycle ergometry. During submaximal and peak exercise, large increases in left- and right-sided filling pressures were demonstrated. Maximal oxygen uptake was severely reduced and ventilatory efficiency was severely elevated. Multiple pulmonary vascular and right-sided hemodynamic parameters were predictive of functional capacity.

KW - Exercise

KW - Heart failure with reduced ejection fraction

KW - Hemodynamics

KW - Pulmonary vascular disease

UR - http://www.scopus.com/inward/record.url?scp=85152965510&partnerID=8YFLogxK

U2 - 10.1016/j.cardfail.2023.01.010

DO - 10.1016/j.cardfail.2023.01.010

M3 - Article

C2 - 36871613

VL - 29

SP - 1276

EP - 1284

JO - Journal of cardiac failure

JF - Journal of cardiac failure

SN - 1071-9164

IS - 9

ER -